IJCS | Volume 32, Nº1, January/ February 2019

85 Ghorayeb et al. Sudden cardiac death in sports: not a fatality! Int J Cardiovasc Sci. 2019;32(1)84-86 Viewpoint undergoing that assessment because they are concerned about being excluded from sports competition. The world scenario has changed after the tragic death of the African soccer player Foé, in June 2003 in Lyon, France, witnessed during the Confederations Cup, secondary to hypertrophic cardiomyopathy. In the following months, other deaths of soccer players occurred, such as the Polish player Fehér in January 2004 in Portugal, secondary to pulmonary thromboembolism, and the Brazilian player Serginho, of the São Paulo State premier league team, in October 2004, also secondary to hypertrophic cardiomyopathy. Because of such tragedies, the leaders began to investigate what should be done to prevent these events, in addition to enforcing the availability of emergency medical support with portable defibrillators in sports events in Brazil and worldwide. Professional and amateur athletes of competitive sports shouldundergopreparticipation cardiovascular screening, an effective preventative strategy to avoid sudden death in sports, an event considered paradoxical because it occurs in a trained individual, a symbol of health, an example to the entire society. To corroborate our statement, we have statistical data fromour Service of Sports Cardiology of the IDPC with approximately 14,000 athletes and ex-athletes cared for in the past 40 years, in addition to those from the Sports Medicine Clinic (ex-Sport Check-up HCor) of the Hospital do Coração (HCor), with approximately 1,000 athletes assessed in 10 years, mainly from 4 São Paulo State premier league teams. 4 Sports cardiology of the IDPC and HCOR 1. Assessment of children and adolescents (“Soccer Sieve”: a gateway for young individuals to play for a major league team): Diagnostic results in 180 adolescents: A. cleared for sports practice: 139 (77.3%) B. comorbidities (anemia, asthma, type 1 diabetes mellitus, athlete’s identified proteinuria syndrome): 9 (5%), 1 (0.5%) disqualified for sports competition C. heart diseases: 32 (17.7%): • disqualified for sports competition: 19 (10.5%), 1 death due to early coronary artery disease • treated or recommended to change sports modality: 13 (7.2%) D. Reason of the assessment: • 110 (61%): preparticipation evaluation • 70 (39%): presence of symptoms or abnormal tests 2. Preparticipation evaluation of Brazilian Olympic athletes Diagnosis of 126 Brazilian Olympic athletes: A. Normal results: 7.6% B. Athlete’s heart: 51% C. Physiological arrhythmias: 2% D. Mitral valve prolapse: 10% E. Dyslipidemia: 25% 3. Assessment of 5,000 athletes by the IDPC Cardiac abnormalities and/or heart diseases: A. From 7 to 14 years of age: 21% B. From 15 to 17 years of age: 17.7% C. From 18 to 35 years of age: 8.2% Sports practice is not a primary cause of sudden cardiac death. However, we believe that overtraining, use of licit (anabolic steroids, GH, amphetamines) and illicit drugs, and undiagnosed or undervalued heart diseases are the major causes of cardiac arrest and, consequently, sudden cardiac death. Most of the common causes of sudden cardiac death can be identified by preparticipation evaluation of athletes performed by experienced doctors. Fatality is a death caused by an accident or a situation we couldn't avoid. Sudden cardiac death in athletes is a preventable event. A recent study reported interesting data about triathlon competition, an endurance and high-intensity sport: “Deaths and cardiac arrests during triathlon are not rare as imagined, most of themoccurring inmiddle-aged men and those older than 60 years”. Most of the deaths occurred during swimming, a modality with difficult visual control of the possible events. The most important and surprising finding was the high incidence of silent cardiac abnormalities, particularly atherosclerotic coronary artery disease. 5 In Brazil, sudden death in sports usually occurs in athletes who never underwent a preparticipation evaluation, mainly amateurs and those participating in intense physical activities at fitness centers. Many individuals presented arrhythmias, mostly secondary to viral myocarditis, the major cause of cardiac events in sports in Brazil.